Citation Nr: 0334176
Decision Date: 12/08/03 Archive Date: 12/16/03
DOCKET NO. 93-09 479A ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Columbia,
South Carolina
THE ISSUES
1. Entitlement to service connection for a bilateral knee
disability, secondary to pulmonary sarcoidosis.
2. Entitlement to service connection for a bilateral ankle
disability, as secondary to pulmonary sarcoidosis.
3. Entitlement to service connection for a bilateral
shoulder disability as secondary to pulmonary sarcoidosis.
4. Entitlement to service connection for a disability
manifested by body cramps as secondary to pulmonary
sarcoidosis.
5. Entitlement to service connection for a disability
manifested by a sore throat and a chronic cough, as secondary
to pulmonary sarcoidosis.
6. Entitlement to service connection for a cardiovascular
disability as secondary to pulmonary sarcoidosis.
7. Entitlement to service connection for ulcers as secondary
to pulmonary sarcoidosis.
8. Entitlement to service connection for a liver disability
as secondary to pulmonary sarcoidosis.
9. Entitlement to service connection for a spleen disability
as secondary to pulmonary sarcoidosis.
10. Entitlement to an increased rating for sarcoidosis,
currently evaluated as 30 percent disabling.
11. The propriety of the initial noncompensable rating for
sarcoid skin lesions.
12. The propriety of the initial noncompensable rating for
dry eye and conjunctivitis, for the period preceding December
13, 2001.
13. The propriety of the initial 20 percent rating for dry
eye and conjunctivitis, for the period beginning December 13,
2001.
14. The propriety of the initial 20 percent rating for
diabetes.
15. Entitlement to a total rating based on individual
unemployability (TDIU).
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
W. R. Steyn, Counsel
INTRODUCTION
The veteran had active military service from January 1952 to
November 1953 and from October 1957 to May 1973.
This appeal arises before the Board of Veterans' Appeals
(Board) from a September 1992 rating decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Columbia, South Carolina, which denied the veteran's claim
seeking entitlement to an increased rating for sarcoidosis
from 30 percent disabling and denied entitlement to an
increased (compensable) rating for hearing loss. The appeal
also arises from a January 1994 rating decision which denied
entitlement to service connection for a skin disability on a
direct basis and denied entitlement to a TDIU. The January
1994 rating decision also denied entitlement to service
connection for arthritis in both legs, to include the knees
and ankles, arm problems, bursitis, body cramps, an eye
condition, and a sore throat and cough, all as secondary to
the veteran's service-connected sarcoidosis.
On a form dated February 2000, the veteran indicated that the
hearing issue was satisfactorily resolved. Accordingly, the
issue of an increased (compensable) rating for bilateral
hearing loss is no longer in appellate status.
By rating decision dated January 2000, the RO denied service
connection for ulcer, liver and spleen disabilities as
secondary to pulmonary sarcoidosis, and a heart disability.
The RO also granted service connection for dry eye and
conjunctivitis, as well as for sarcoid skin lesions and
assigned noncompensable ratings for both disabilities. The
veteran disagreed with the 4 denials of service connection,
as well as with the initial noncompensable ratings assigned
for dry eye and conjunctivitis and sarcoid skin lesions. The
RO thereafter issued a statement of the case regarding these
6 issues. As the veteran subsequently submitted a
substantive appeal regarding these 6 issues, it is determined
that they also are in appellate status.
The appeal also arises from a February 2002 rating decision
which granted service connection for diabetes and assigned a
20 percent rating.
The veteran's claim was remanded in June 1999 and February
2001.
By rating decision dated May 2002, the RO granted the veteran
an increased rating for his dry eye and conjunctivitis to 20
percent effective December 13, 2001.
REMAND
Regarding the veteran's claim for a TDIU, it is noted that in
April 2002, the veteran indicated that he had sought VA
assistance through vocational rehabilitation. However, these
records are not in the claims folder. For that reason, the
veteran's claim for a TDIU (as well as the claim for an
increased rating for sarcoidosis, and the claims challenging
the propriety of the initial ratings for sarcoid skin
lesions, dry eye and conjunctivitis, and diabetes) must be
remanded in order to obtain these records.
Although the veteran had examinations for his service-
connected sarcoidosis, skin lesions, conjunctivitis, and
diabetes in December 2001, the duty to assist includes
conducting a thorough and contemporaneous examination of the
veteran that takes into account the records of prior medical
treatment. Green v. Derwinski, 1 Vet.App. 121 (1991). In
light of the need to remand the veteran's claim for the
development cited above, it is determined that the veteran
should be afforded a VA examination to determine the severity
of the aforementioned disabilities.
Regarding the veteran's claim of service connection for
ulcer, liver, spleen, and cardiovascular disabilities, the
veteran claims that these disorders are proximately due to
his service-connected sarcoidosis. The veteran should be
scheduled for a VA examination in order to clarify the nature
and etiology of any stomach, liver, spleen, and
cardiovascular disorders. The examiner should determine
whether any stomach (specifically ulcers), liver, spleen, or
cardiovascular disorders are proximately due to or the result
of his service-connected sarcoidosis, or whether the
veteran's sarcoidosis aggravated any identified disorders.
See Allen v. Brown, 7 Vet. App. 439 (1995).
To ensure full compliance with due process requirements, the
case is REMANDED for the following development:
1. The RO should obtain the veteran's
vocational rehabilitation records. The
RO should also ensure that copies of all
current relevant medical reports are
included in the claims folder.
2. The veteran should be afforded a VA
examination to determine the current
severity of his service-connected
sarcoidosis, skin lesions, and diabetes.
The examiner should also determine the
nature and etiology of any stomach
(specifically ulcers), liver, spleen, and
cardiovascular disorders. All indicated
testing in this regard should be
accomplished, including pulmonary
testing. If it is necessary for the
veteran to be examined by different
specialists in order to answer the
following questions, the RO should
arrange for those separate examinations.
The claims folder should be made
available to the examiner for review in
conjunction with the examination. The
examiner should answer the following
questions:
a. Describe all symptomatology and
manifestations of the veteran's
sarcoidosis.
b. Does the veteran have pulmonary
involvement with persistent symptoms
requiring chronic low dose
(maintenance) or intermittent
corticosteroids?
c. Does the veteran have pulmonary
involvement requiring systemic high
dose (therapeutic) corticosteroids
for control?
d. Describe the severity of any
fibrosis that might be present,
specifically in terms of whether it
might be considerable or extensive.
e. Describe the severity of any
dyspnea that might be present,
specifically in terms of whether it
might be moderate or severe on
slight exertion.
f. Regarding pulmonary testing,
what is the predicted value of the
Forced Expiratory Volume in one
second?
g. Regarding pulmonary testing,
what is the ratio of Forced
Expiratory Volume in one second to
Forced Vital Capacity?
h. Regarding pulmonary testing,
what is the predicted value of the
Diffusion Capacity of the Lung for
Carbon Monoxide by the Single Breath
Method?
i. Regarding pulmonary testing,
what is the maximum oxygen
consumption of 15 to 20 ml/kg/min
(with cardiorespiratory limit)?
j. Does the veteran have cor
pulmonale (right heart failure)?
k. Does the veteran have right
ventricular hypertrophy?
l. Does the veteran have pulmonary
hypertension?
m. Has the veteran had episodes of
acute respiratory failure?
n. Does the veteran require
outpatient oxygen therapy?
o. Is the veteran unable to obtain
or maintain gainful employment, and
if he is deemed so unable, is it at
least as likely as not that the
reason for the veteran's inability
to obtain and maintain gainful
employment is his service-connected
disabilities (sarcoidosis, diabetes,
skin lesions, conjunctivitis)?
Regarding the veteran's diabetes, the
examiner should answer the following
questions:
a. Does the veteran require insulin
ejections?
b. Does the veteran need a
restricted diet and regulation of
his activities?
c. Does the veteran have episodes
of ketoacidosis or hypoglycemic
reactions requiring one or two
hospitalizations per year or twice a
month visits to a diabetic care
provider?
Regarding the veteran's sarcoid skin
lesions, the examiner should answer the
following questions:
a. Does the veteran have
exfoliation, exudation, or itching?
b. Does the veteran have constant
itching, extensive lesions, or
marked disfigurement?
c. Does the veteran have ulceration
or extensive exfoliation or
crusting?
d. Does the veteran have systemic
or nervous manifestations?
e. Does the veteran require
systemic therapy such as
corticosteroids or other
immunosuppressive drugs, and if so,
for what length of time does he
require such systemic therapy?
f. What percentage of the veteran's
body or exposed areas are affected
by the veteran's skin lesions?
Regarding the veteran's dry eye and
conjunctivitis, the examiner should
comment on the severity of said disorder.
A separate examination with a specialist
should be conducted if deemed necessary.
Regarding the veteran's stomach, liver,
spleen, and cardiovascular system, the
examiner should answer the following
questions:
a. Identify all disorders of the
stomach, liver and spleen. The
examiner should specifically comment
on whether the veteran has ulcers.
b. For each disorder identified in
response to item a, above, state a
medical opinion as to whether it is
at least as likely as not that the
disorder is proximately due to or
the result of the veteran's service-
connected sarcoidosis?
c. If such disorders identified in
question (a) are unrelated to
service or to the veteran's
sarcoidosis, did the veteran's
service-connected sarcoidosis
disability aggravate such disorders
beyond the natural progression of
such disorders? All opinions
expressed should be supported by
reference to pertinent evidence.
d. Identify all cardiovascular
disorders.
e. Is it at least as likely as not
that any cardiovascular disorders,
are proximately due to or the result
of the veteran's service-connected
sarcoidosis?
f. If such disorders identified in
question (d) are unrelated to
service or to the veteran's
sarcoidosis, did the veteran's
service-connected sarcoidosis
disability aggravate such disorders
beyond the natural progression of
such disorders? All opinions
expressed should be supported by
reference to pertinent evidence.
3. All notice and duty-to-assist
provisons of the Veterans Claims
Assistance Act of 2000 (VCAA), Pub. L.
No. 106-475, 114 Stat. 2096 (2000) must
be properly applied in the development of
the veteran's claims.
4. After all requested development has
been completed, the RO must re-adjudicate
the claims
If this action does not result in an
allowance of the veteran's claim, he
should be provided a supplemental
statement of the case. Thereafter, the
case should be returned to the Board.
No action is required of the veteran until he receives
further notice, and the Board does not intimate any factual
or legal conclusion as to any final outcome warranted in the
appeal.
The appellant has the right to submit additional evidence and
argument on the matter or matters the Board has remanded to
the regional office. Kutscherousky v. West, 12 Vet. App. 369
(1999).
These claim must be afforded expeditious treatment by the RO.
The law requires that all claims that are remanded by the
Board of Veterans' Appeals or by the United States Court of
Appeals for Veterans Claims for additional development or
other appropriate action must be handled in an expeditious
manner. See The Veterans' Benefits Improvements Act of 1994,
Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994),
38 U.S.C.A. § 5101 (West 2002) (Historical and Statutory
Notes). In addition, VBA's Adjudication Procedure Manual,
M21-1, Part IV,
directs the ROs to provide expeditious handling of all cases
that have been remanded by the Board and the Court. See M21-
1, Part IV, paras. 8.44-8.45 and 38.02-38.03.
_____________________________________
G.H. Shufelt
Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Appeals for Veterans Claims. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (2002).